The effect of staged TIP urethroplasty on proximal hypospadias with severe chordee.

Background: Proximal hypospadias with severe chordee is still a formidable challenge for most pediatric urologists, and the treatment approach remains controversial. Here, we describe a modified two-stage technique to repair proximal hypospadias with severe chordee. Methods: We retrospectively identified 53 children referred for proximal hypospadias with severe chordee from July 2016 to July 2019, who underwent a two-stage urethroplasty. In group 1, the children were repaired with staged tubularized incised plate (TIP) urethroplasty, while Byars' two-stage urethroplasty was attempted in group 2. We corrected chordee by releasing all remaining attachments to the corpora after degloving the penis, transceting the urethral plate, and dorsal plication. The mean age of patients in the first stage of surgery was 26.6 months in group 1 and 24.8 months in group 2. Postoperative complications in the two groups included: fistula, urethral stricture, urethral diverticulum, and glanular dehiscence. Results: A total of 20 cases were repaired with staged TIP urethroplasty (group 1), and 33 cases were repaired with Byars' two-stage urethroplasty (group 2). The length of follow-up in group 1 was 39.8 ± 10.1 months, and in group 2, it was 38.1 ± 8.7 months (P > 0.05). After the second stage of surgery, 1 case (5%) in group 1 and 11 cases (33.3%) in group 2 developed a urinary fistula (P < 0.05). One case (5%) in group 1 and three cases (9.1%) in group 2 had urethral stricture (P > 0.05). All strictures were cured by repeated dilation, and no patient required reoperation. No cases in group 1 and one case (3%) in group 2 had urethral diverticulum (P > 0.05). There was no residual chordee in both groups. Two cases (10%) in group 1 and 13 cases (39.3%) in group 2 required reoperation (P < 0.05). Conclusions: Staged urethroplasty is appropriate to repair proximal hypospadias with severe chordee. Particularly, staged TIP urethroplasty is a good choice for patients with proximal hypospadias and severe chordee, especially those with better penile development, wider urethral plate, larger glans, and deeper navicular fossa of the urethra.

Diagnosis, management, and outcome of urethral obstruction secondary to the capsule associated with the artificial urethral sphincter device.

BACKGROUND: Urethral obstruction secondary to artificial urethral sphincter (AUS) implantation is a recognized complication in dogs. However, urethral obstruction secondary to AUS-associated capsule formation has been described rarely. HYPOTHESIS: Describe clinical and diagnostic findings, management, and outcome in 6 dogs with urethral obstruction secondary to AUS-associated capsule formation. ANIMALS: Six client-owned dogs. METHODS: Retrospective study. Medical records between January 1, 2010, and June 30, 2021, were reviewed to identify dogs with urethral obstruction associated with the AUS device. RESULTS: The AUS device was implanted a median of 884 days (range, 20-2457 days) before presentation for urethral obstruction. Median age at time of urethral obstruction was 4.7 years (range, 3.1-8.7 years). Clinical signs at the time of urethral obstruction were stranguria (n = 4), pollakiuria (3), weak urine stream (2), and worsened urinary incontinence (1). In all dogs, the urethra was noted to be stenotic during urethroscopy and positive contrast cystourethrography. All dogs underwent surgery, and a fibrous capsule associated with the AUS was found to be causing urethral stenosis. Resolution of urethral obstruction occurred in all dogs after transection or removal of the capsule. Positive bacterial cultures were obtained from the capsule, AUS, or both in all dogs. Recurrence of urethral obstruction had not occurred in any dog at the time of follow-up. CONCLUSIONS AND CLINICAL IMPORTANCE: Urethral obstruction secondary to capsule formation is an uncommon but clinically important complication associated with use of the AUS. Continued investigation is needed to evaluate this complication more thoroughly, and its possible association with infection.

The median effective dose (ED50) of cis-Atracurium for laryngeal mask airway insertion during general Anaesthesia for patients undergoing urinary surgery.

BACKGROUND: In clinical practice, the laryngeal mask airway is an easy-to-use supraglottic airway device. However, the cis-atracurium dosage for laryngeal mask insertion has not been standardised. We aimed to determine the optimal dose of cis-atracurium using a sequential method for successful laryngeal mask insertion. METHODS: The cohort study protocol is registered at clinicaltrial.gov (NCT-03668262). Twenty-three patients undergoing elective urinary surgery were sequentially administered cis-atracurium doses as follows: 150, 100, 70, 50, 30, and 20 µg·kg- 1. The main outcome involved the determination of the response to laryngeal mask airway insertion: ≥16 points and < 16 points indicated "satisfactory" and "unsatisfactory" responses, respectively. The median effective dose was estimated using the mean of the seven crossovers from "satisfactory" and "unsatisfactory" responses. The primary outcome involved the determination of the median effective dose (ED50) of cis-atracurium for laryngeal mask airway insertion. RESULTS: The median effective dose of cis-atracurium was 26.5 µg·kg- 1 (95% CI 23.6-29.8) using the sequential method. Heart rate was decreased in the 50 µg·kg- 1 group compared to that in the 30 µg·kg- 1 group at timepoints T7, T8, and T10 (P = 0.0482, P = 0.0460, and P = 0.0236, respectively), but no difference was observed in the 20 µg·kg- 1 group. Systolic blood pressure was decreased in the 50 µg·kg- 1 group compared to that in the 20 µg·kg- 1 group at timepoints T2, T3, and T4 (P = 0.0159, P = 0.0233, and P = 0.0428, respectively). The train-of-four value was significantly lower in the 50 µg·kg- 1 group than in the 30 µg·kg- 1 group at timepoint T3 (P = 0.0326). CONCLUSIONS: The ED50 of cis-atracurium was 26.5 µg·kg- 1 for laryngeal mask airway insertion. TRIAL REGISTRATION: Clinicaltrial.gov Registry, NCT03668262, Registered on 11 September 2018.

Establishment and Effect of Management and Control Model for Perioperative Prophylactic Use of Antibiotics in Urinary Surgery Department of A Hospital / 中国药房

OBJECTIVE： To provide reference for perioperative prophylactic use of antibiotics in urinary surgery department. METHODS： In response to irrational perioperative prophylactic use of antibiotics in urinary surgery department， taking type Ⅱ incision surgery and special diagnosis and treatment and preventive drug use as an example， the management and control mode for perioperative prophylactic use of antibiotics was established and intervened in urinary surgery department so as to intervene in antibiotics use through formulating surgical type risk classification system， forming perioperative medication clinical pathways such as type Ⅱ incision surgery and urinary calculi surgery with different infection risk， establishing tracking and supervision mechanism. The rationality indexes of perioperative prophylactic medication such as the rate of prophylactic antibiotics use were compared among related medical records collected from urinary surgery department within 3 months before and after intervention （186 records before intervention， 179 records after intervention）. Antibiotics use density （AUD） and amount of antibiotics in urinary surgery department were compared within 3 months before and after intervention to evaluate management and control effect. RESULTS： Among surveyed medical records， compared with before intervention， the rate of prophylactic antibiotics use was decreased from 97.3％ （181/186） to 91.6％ （164/179）； the rate of rational drug selection was increased from 17.7％ （32/181） to 71.3％ （117/164）； correct rate of medication timing was increased from 9.9％ （18/181） to 32.3％ （53/164）； the rate of rational post-operative prevention course was increased from 17.1％ （31/181） to 37.2％ （61/164）， with statistical significance （P＜0.05 or P＜0.01）. Average AUD was deceased from 83 DDD to 70 DDD within 3 months after intervention， and the amount of antibiotics was decreased from 689 669.23 yuan to 531 040.11 yuan. CONCLUSIONS： Established management and control mode for perioperative prophylactic use of antibiotics in type Ⅱ incision surgery and special diagnosis and treatment and preventive drug use can effectively reduce the rate of prophylactic antibiotics， AUD and amount of antibiotics in urinary surgery department， and promote rational use of antibiotics during perioperative period.

[Anatomic application of the genitofemoral nerve in uroandrological surgery].

The genitofemoral nerve (GFN) has its unique anatomic characteristics of location, run and function in the male urinary system and its relationship with the ureter, deferens and inguinal region is apt to be ignored in clinical anatomic application. Clinical studies show that GFN is closely correlated with postoperative ureteral complications and pain in the inguinal region after spermatic cord or hernia repair. GFN transplantation can be used in the management of erectile dysfunction caused by cavernous nerve injury. Therefore, GFN played an important role in the clinical application of uroandrology. This review summarizes the advances in the studies of GFN in relation to different diseases in uroandrology.

Application of "three-step teaching model" for minimally invasive simulation training in urologic clinical teaching / 基础医学与临床

Objective To explore the effectiveness of applying minimally invasive simulation training in urologic clinical teaching .Methods Interns, training clinicians and junior doctors in our hospital, each group of six people, participating in the newthree-step teaching model of "theory learning +simulation training +clinical practice".The score before and after training on their theoretical knowledge , simulation training skills and clinical practice were assessed and the results were analyzed .Results The test scores of minimal invasive techniques theoretical knowl-edge and clinical practice assessment were significantly enhanced before training and after training ( P<0.05 ) .We have established a standardized minimally invasive simulation training in urologic clinical teaching .Conclusions Minimally invasive simulation training provides an effective and safe learning cultivation method for clinician and medical students , which could improve the clinical practice skills of young doctors in minimally invasive surgery as well as shorten the learning curve .

Anatomic application of the genitofemoral nerve in uroandrological surgery / 中华男科学杂志

The genitofemoral nerve (GFN) has its unique anatomic characteristics of location, run and function in the male urinary system and its relationship with the ureter, deferens and inguinal region is apt to be ignored in clinical anatomic application. Clinical studies show that GFN is closely correlated with postoperative ureteral complications and pain in the inguinal region after spermatic cord or hernia repair. GFN transplantation can be used in the management of erectile dysfunction caused by cavernous nerve injury. Therefore, GFN played an important role in the clinical application of uroandrology. This review summarizes the advances in the studies of GFN in relation to different diseases in uroandrology.

Laparoscopic-Assisted Surgical Procedures.

Laparoscopic-assisted procedures allow a balance between the improved patient recoveries often associated with smaller incisions and the need for appropriate visualization of visceral organs/identification of lesions. The organ systems of small animal veterinary patients that are highly amenable to laparoscopic-assisted procedures include the urinary bladder, the gastrointestinal tract, and the reproductive tracts. Laparoscopic-assisted procedures are especially beneficial in the approach to luminal organs, allowing the organ incision to be exteriorized through the body wall, protecting the peritoneal cavity from contamination from luminal contents. Procedure-specific morbidities and patient selection should be considered when choosing between assisted laparoscopic and open approaches.

The effects of sevoflurane inhalation anesthesia and spinal canal anesthe-sia on cognitive function in patients with urinary surgery in the elderly / 中国现代医生

Objective To observe the effects of sevoflurane inhalation anesthesia and spinal canal anesthesia on cogni-tive function in patients with urinary surgery in the elderly. Methods Researched 68 patients that undergoing elective urinary surgery in elderly patients, and then randomly divided into the sevoflurane inhalation anesthesia group (group A) and spinal canal anesthesia group (group B). The two groups were recorded time of anesthesia operation, surgical blood loss and transfusion volume, low blood pressure and the number of hypoxemia occurred, at last used the simple mental state examination (MMSE) to evaluate two groups of patients with 1 d before anesthesia and postoperative 1 d, 3 d, 7 d cognitive function. Results Two groups of anesthesia operation in time, surgical blood loss and transfusion volume, low blood pressure and the number of hypoxemia occurred had no significant differences(P>0.05). Two groups of postoper-ative 1 d, 3 d MMSE score were significantly lower than before operation, and the group A was significantly lower than group B, the differences were statistically significant(P <0.05);MMSE of A group ofter treatment for 7days were signifi-cantly lower than before the operation, but there was no significant difference compared with controls of groupA ofter treatment for 7 days (P>0.05); The incidence of POCD postoperative 1 d and 3 d in groupA were significantly higher than that of group B, with significant difference (P<0.05), and the incidence of POCD difference of two groups of post-operative 7 d was not significant (P >0.05). Conclusion Sevoflurane inhalation anesthesia is spinal canal anesthesia cognitive dysfunction occurred more often in patients with elderly urinary surgery.

Application of internet-assisted platform combined with CBL in teaching of urinary surgical nursing / 现代临床护理

Objective To explore the effects of the internet-assisted platform combined with case-based learning(CBL)in teaching of urinary surgical nursing.Methods Eighty-seven students from the same grade were divided into experiment group(n=44) and control group(n=43)according to their natural class. Internet-assisted platform combined with CBL was used in the experiment group,while the traditional teaching mode was used in the control group during the teaching of urinary surgical nursing. The results of examination on the nursing theory in the two groups were compared. A questionnaire survey was conducted on the test group.Results The score on nursing theory in the test group was significant higher than that in the control group(P<0.05). More than 86.36%students were positive about the internet-assisted platform combined with CBL in the experiment group.Conclusions The internet-assisted CBL can make the teaching more vivid and interesting.It cultivates the students’critical thinking,improves the students’ability of autonomous learning,which as a result of improving teaching effects.

Application of seminar teaching method in clinical teaching of department of urinary surgery / 中华医学教育探索杂志

Objective To evaluate the teaching effect of seminar method in clinical teaching of department of urinary surgery.Methods A total of 30 clinical medical students were randomly divided into two equal groups:test group with seminar teaching method and control group with traditional teaching method.Results Were evaluated by scores of theoretic test,operating skill and survey after 3 months.Results Scores of theoretic test and operating skill in test group were significantly higher than those in control group(P ＜0.05).There were significant differences in scores of survey between two groups(P ＜ 0.05).Conclusions Seminar teaching method could effectively improve student learning initiatives and teaching effect,and is worth further exploration.

Intervention on the Perioperative Use of Antibiotics in Urinary Surgery Patients / 中国药房

OBJECTIVE:To investigate the utilization of antibiotics in urinary surgery patients in our hospital.METHODS:The problems lie in the perioperative use of antibiotics in a total of 600 patients with ureter stones,kidney stones,bladder stones and(or)benign prostatic hyperplasia(BPH)undergoing urinary surgery from Jan.to June in 2006 and from Jan.to June in 2007 were analyzed in accordance with the Guiding Principles of Clinical Application of Antibacterials and the related regulations of antibiotics in our hospital.RESULTS:The rate of rational use of antibiotics rose from 12.5% before intervention to 88.2% after intervention.The problems of improper selection of antibiotics,irrational timing and too long duration of drug use were improved to a great extent.CONCLUSION:The intervention on the rational perioperative use of antibiotics is effective and it greatly enhanced the rationality in the perioperative use of antibiotics in urinary surgery patients.

Multimedia Teaching in the Clinical Practice of Urology / 中华医学教育探索杂志

The clinical practice is a bridge between theoretical learning and clinic practice.The learning interests of medical students can be enhanced and the teaching effects be improved by using multimedia teaching in the clinical practice of urology.

Application of Problem-based Learning Pattern in Clinical Teaching Urinary Surgery / 中华医学教育探索杂志

For adapting the demands of modern society to medical talents,we applied problem-based learning pattern to urology practice teaching.By breaking the limits of subjects,we enable students to acquire more knowledge of science and problem-solving skills and self-learning skills in the limited time available.The role of teacher shifts from imparting knowledge to leaders.

How to Improve Medical Students' Clinical Practice Quality of Urinary Surgery in Clinical Teaching / 中华医学教育探索杂志

The author summed up how to improve the urologic practice teaching quality from the following seven aspects: To give students a full understanding of urology clinical practice;To pay attention to the professional quality of teachers;To emphasize the training of interns agility;To organize intern participated in case discussion;To pay attention to the important role of writing medical record in clinical practice teaching;Properly handle the relationship between clinical practice and taking part in the entrance exams for postgraduate schools and employment options;To enhance the quality of medical humanities education in clinical teaching.